CAR-T Therapies Approved on a Case-by-Case

July 17, 2018

Insurers are proceeding cautiously, but the large insurers are speeding up their approvals.

Kymriah (tisagenlecleucel) and Yescarta (axicabtagene ciloleucel) cost $373,000 to treat adults with advanced lymphomas, while Kymriah costs $475,000 to treat acute lymphoblastic leukemia in children and young adults, according to Kaiser Health News. Many patients experience serious side effects require ICU care. Treatment costs can pile up to more than a $1 million.

However, most commercial insurers are covering CAR-T therapies, but they do so on an individual basis, writing single-patient agreements each time, cancer experts told KHN. And large insurers that are already familiar with complicated therapies like stem cell transplants are getting speedier at handling CAR-T treatment requests, the experts told news services. It is a different story with small or regional plans where approval can take weeks for patients who are fighting cancer after other treatments failed.